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Incorrect coding and documentation errors of ASC claims for CPT code 63685
Last Modified: 1/3/2023
Location: FL, PR, USVI
Business: Part B
Did you know claims reviewed by the recovery auditor (RA) in 2021 for CPT code 63685 performed in an ambulatory surgery center (ASC) were among the top denials for incorrect CPT coding, incorrect modifier coding and insufficient documentation errors?
ASC coding requires procedural information, as coded and reported by the facility on its claim, should match both the attending physician's description and the information contained in the beneficiary's medical record. RA reviewers validate the CPT or HCPCS coding and associated modifiers by reviewing the procedures affecting or potentially affecting payment.
Let’s review information on this code and how you can avoid these errors.
Claims reviewed indicated ASCs were billing this procedure code erroneously, either using the incorrect CPT code to describe the procedure being performed or incorrect modifiers were applied. When documentation was requested by the RA, either the documentation was insufficient to substantiate the claim and the code selected or no documentation was provided at all.
Reminders:
• All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
• If documentation should be requested, be sure to respond timely with proper records to the requesting contractor.
• Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
• The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT or HCPCS code must describe the service performed.
Descriptor -- Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling
CPT code 63685 includes the creation of a subcutaneous pocket made to house the stimulator and tunneling of the electrodes to the pocket and would be reported in addition to CPT code 63650, for the insertion or replacement of the pulse generator or receiver.
Here are tips to avoid errors when billing this code:
• CPT code 63650 (percutaneous implantation of neurostimulator electrode array, epidural) is not altered when the implantation of the percutaneous epidural neurostimulator electrode is performed for the purpose of a "temporary" trial or for "permanent" neurostimulation.
• The difference between the two procedures is the attachment of the electrode array to an external stimulator unit for trial stimulation as opposed to connecting to an implanted pulse generator or receiver for permanent stimulation. Attachment to an external stimulator unit is considered inherent to the work represented by CPT code 63650. Therefore, it is not appropriate to report CPT code 63685 for the attachment to an external stimulator.
• Revision or removal of implanted spinal neurostimulator pulse generator or receiver is performed with CPT code 63688, not CPT code 63685.
Providers performing this procedure should familiarize themselves with the associated LCD, national coverage determinations (NCDs) and billing and coding articles to ensure claims billed for these procedures use the correct CPT codes and required diagnosis code(s). Remember you should select codes which appropriately reflect the service being rendered for the claim(s) submitted.
Before submitting the claim for these procedures, remember:
• Review the long descriptor for the CPT or HCPCS code you are billing. The short descriptors are limited to 28 characters, and do not always capture the complete description of the procedure.
• Use the correct CPT or HCPCS code to describe the procedure(s) performed.
• Ensure your documentation supports the code(s) being billed.
• If documentation is requested, be sure to respond timely with proper records to the requesting contractor.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.